Should You Take a Placebo?

A placebo (Latin for “I shall please”) is a sham treatment, such as a dummy pill, customarily administered to someone who is unaware that it’s not a “real” treatment. The benefit it can produce is called the placebo effect, which occurs when belief in a treatment or in the power of a trusted practitioner actually helps the “remedy” work and triggers an improvement in symptoms and health. Since ancient times it has been known that the hope and expectation people experience when treated—even with a sugar pill—can play a role in recovery. But what if people in pain are told that a treatment is a placebo? Could that possibly help them?

Yes, according to a study from Portugal in the journal Pain, which in­­cluded 83 adults with chronic low back pain. Half were randomly assigned their usual pain medications alone; the other half got their usual medications plus a placebo.

But unlike “gold standard” double-blind, placebo-controlled clinical trials—in which the placebo provides a yardstick against which the treatment is measured and neither the participants nor researchers know who is getting the sham treatment—the placebo group in this study received dummy pills labeled “placebo.” What’s more, the researchers explained the potential power of the placebo effect and how the body may respond.

After three weeks, the placebo group re­­ported a clinically significant 30 percent re­­duc­­tion in pain and disability, compared to little or no improvement in the usual-treatment group. People who weren’t initially assigned the placebo were offered the chance to take it later; when the took it, they had similar improvements.

Low back pain is often hard to treat, and there’s a great need for effective treatments. Conventional clinical trials often find that commonly prescribed treatments for back pain are not significantly more effective than a placebo but have more side effects.

So why not just give patients placebos? If doctors lead patients to believe that a placebo is a real drug, that’s deception. Giving placebos openly—and explaining how the placebo ef­­fect can work—offers a way to overcome this ethical problem.

This study was short, so it’s not known if the placebo’s benefits would have persisted. In addition, it was advertised as a “novel mind-body clinical study,” so it might have attracted people who are particularly open to complementary and alternative treatments.

“Our data suggest that open-label placebo can be a safe and effective adjunct to treatment for chronic low back pain,” the researchers concluded. They called for further research evaluating the potential for “harnessing placebo effects without deception” for back pain and other conditions.